Treatment of gram-negative shock

A brief review of the treatment of gram-negative shock is presented. Particular attention is given to some of the newer concepts of therapy and their application to correct the hemodynamic derangement of bacteremic shock. The survival rate of 90.5 per cent in twenty-one nonleukemic patients receiving massive doses of corticosteroids at Emory University Hospital represents a response to therapy hitherto unreported. Other factors must be taken into account in the assignment of credit for therapeutic success including the use of the newer antibiotics, cephalothin and kanamycin, better fluid, electrolyte and metabolic management, central venous pressure monitoring, beta adrenergic stimulation and dextran. Pharmacologic doses of steroids may favorably influence the course of gram-negative shock by virtue of a positive inotropic effect, enhancement of the microcirculation and lysosome stabilization. Other effects may be operative but these are as yet unknown. Maintenance of adequate ventilation and judicious fluid administration are of prime importance in the treatment of any patient in shock. In assessing the response to therapy, the primacy of parameters of perfusion over blood pressure per se is stressed.